19 December 2012

A malevolent tooth fairy?

We are concerned that the actions of the mythical character
at the root of this report must be brought to the attention of the
medical community, as it seems to represent the first signs of a
worrying new trend in malpractice.
Previous anecdotal evidence suggests the tooth fairy is benevolent, but
this opinion may need revising in light of mounting reports of less
child-friendly activity.

An 8 year old boy was referred
to a specialist allergy clinic with a history of profuse mucopurulent
rhinorrhoea. After a failure of first line medical treatment, computed
tomography of the sinuses was performed. This revealed clear evidence of
changes consistent with sinusitis but also a calcified foreign body in
the left external auditory meatus (figure).

The family spoke of an occasion three years earlier when the
boy had woken from sleep, extremely distressed because the tooth fairy
had put a tooth in his left ear. The tooth had initially been left under
his pillow for the tooth fairy to collect and to leave some money in
its place. Thinking this was a bad dream, the parents initially
reassured the boy but were unable to locate the tooth. Nevertheless, his
concerns continued, and on two occasions advice was sought from
different general practitioners, when the auroscopy was thought to be
normal.

Repeat auroscopy by the allergist confirmed the
presence of a deciduous tooth in the auditory canal. The tooth was
removed by an ENT surgeon...

[I've added a yellow arrow to the head CT to clarify the position of the tooth].

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